Grove Villa Care is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service has not been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service did not always receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

The service was a large home, bigger than most domestic style properties. It was registered for the support of up to 18 people. Thirteen people were using the service. This is larger than current best practice guidance. There was a risk that the size of the service had a negative impact on people, there were identifying signs outside of the property and industrial bins which indicated it was a care home. Staff were encouraged to wear a uniform that suggested they were care staff when coming and going with people.

The outcomes for people did not fully reflect the principles and values of Registering the Right Support for the following reasons; people lacked control over their lives, had limited independence, were not included in everything that happened at the service and had limited inclusion in the local community. Some action had been taken since our last inspection to support people to begin to live a fuller life and achieve the better outcomes. However, people had lived at the service for many years and had little or no experience of a service which reflected the principles and values of Registering the Right Support and had not been supported to expect these from any service they received.

People’s experience of using this service:

• At our previous four inspections we found that people received an inadequate service which did not protect them from harm and no significant action had been taken to improve the service people received.

• At this inspection people continued to receive a service which was not well led and managed. They and their loved ones had not been asked for their views of the service to ensure it met their needs and expectations. People were not involved in planning what happened at the service and had not been taken part in the selection of their keyworker or new staff.

• Quality assurance checks had not been completed on the service to identify any shortfalls. The provider and manager did not know about the shortfalls we found at the service.

• Records about people’s care, the staff and governance of the service were not accurate and complete. They were muddled and could not easily accessible. Agency staff who worked alone at night have limited information about people and their needs.

• People continued to be at risk at the service. Despite improvements in the management of safeguarding risks, people were not always protected from other risks, such as the risk of falling or not receiving their medicines safely. One person had lost a significant amount of weight and had not been supported to regain this.

• Effective processes were not in operation to learn lessons and improve the service people received when things went wrong.

• One person’s behaviour which challenged continued to have a negative impact on other people and we observed the atmosphere in the service change when the person returned home and other people were quieter and appeared anxious.

• Robust assessments of people’s needs had not been completed to inform staff about people’s skills and abilities and plan their care and support.

• Care had not been consistently planned to ensure people’s healthcare needs were met consistently and care and treatment was effective.

• Information about people’s equality and diversity ne

We undertook an unannounced focused inspection of Grove Villa Care on 6 and 7 November 2018. This inspection was carried out to check that improvements to meet legal requirements planned by the provider after our comprehensive inspection on 23 and 24 July 2018 had been made. The team inspected the service against two of the five questions we ask about services: is the service well led, is the service safe. This is because the service was not meeting some legal requirements at our last inspection and we had received concerns about people’s safety from the local authority safeguarding team and whistle-blowers.

No significant improvements were identified in the remaining Key Questions through our ongoing monitoring or during our inspection activity so we did not inspect them. The ratings from the previous comprehensive inspection for these Key Questions were included in calculating the overall rating in this inspection.

At the last inspection we found serious concerns regarding the provider’s oversight and overall management of the service continued. Breaches of six regulations continued and there were new breaches of four regulations of the Health and Social Care Act 2008. There was also a continued breach of the Care Quality Commission (Registration) Regulations 2009. The service was rated Inadequate and remained in special measures.

Following our last inspection, the provider sent us improvement action plan to show what they would do and by when to address the breaches. The improvement action plan was not adequate. Despite a request for a more robust plan, the information we received from the provider did not assure us that they understood our concerns and had a plan in operation to address them promptly.

At this inspection we checked to see if concerns in relation to protecting people from abuse, unsatisfactory medicines management, unsafe care, poor staff recruitment and deployment and infection control risks had been addressed. We also checked to see if the management and leadership of the service had improved and the views people and others involved in their care had been used to improve the service. We found the provider had made no significant improvements and people continued to be at risk at the service.

Grove Villa Care is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Grove Villa Care accommodates 16 people in one adapted building. There were 15 people using the service at the time of our inspection. People using the service had a range of physical and learning disabilities. Some people were living with autism and some required support with behaviours that challenged.

The care service had not been developed and designed in line with the values that underpin Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People were not supported to live an ordinary life, like any citizen.

There was no registered manager at the service. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The provider did not have oversight of the service. Checks and audits completed had not identified the shortfalls we found during our inspection. Many areas of the service had not been checked. The views of people, their relatives, staff and community professionals were not obtained to improve the service.

Staff had not been deployed to provide people with the care they needed. Some people remained isolated. Staff had not been recruited safely and checks had not been completed to

This inspection took place on 23 and 24 July 2018 and was unannounced.

Grove Villa Care is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Grove Villa Care accommodates 16 people in one adapted building. There were 15 people using the service at the time of our inspection. People using the service had a range of physical and learning disabilities. Some people were living with autism and some required support with behaviours that challenged.

The care service had not been developed and designed in line with the values that underpin Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People were not supported to live an ordinary life, like any citizen.

A registered manager was employed to manage Grove Villa Care and two other services the provider owned on the same site. The registered manager was not present at the time of our inspection and was not leading the service. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We inspected Grove Villa Care on 20 April 2017 and 18 January 2018 and found significant shortfalls. The service was rated inadequate on both occasions and placed into special measures.

Following our April 2017 inspection, we placed a condition on the provider’s registration, requiring them to send us monthly reports about the actions that had been taken to meet the breaches of regulations found at the inspection. We have not received some these reports as required.

At our last inspection we found that the registered persons had failed to ensure that staff had the necessary guidance to keep people safe. Staff had not been recruitment safely and staff were not appropriately trained and competent to carry out their roles. People were not treated with respect and dignity and did not received person-centred support to communicate their needs. People were not involved in planning their care and had not been supported to take part in pastimes they enjoyed. The registered persons had failed to establish and operate systems to assess, monitor and improve the quality of the services provided and reduce risks to people. People views were not used to improve the service and suitable arrangements were not in place to maintain accurate and complete records. CQC had not been notified about significant events that happened at the service in a timely manner.

We took regulatory action against the provider after our inspection in January 2018 and this is ongoing. Full information about CQC’s regulatory response to the serious concerns found during our inspections is added to reports after any representations and appeals have been concluded.

The service is in special measures. We kept the service under review and inspected the service again within six months to check that the significant improvements required had been made. At this inspection we found that minor improvements had been made in some areas, however there were still serious concerns regarding the registered person’s oversight and overall management of the service. Some breaches of the regulations continued and there were new breaches of other regulations.

The registered persons did not have oversight of the service. Checks and audits of the service had been completed in some areas of the service but these had not identified the shortfalls we found during our inspection. Lessons from previous inspections had not been used to improve the service and there continued to be breaches of five regulations. The views

This inspection took place on 15 January 2018 and was unannounced.

Grove Villa Care is a care home registered to provide accommodation and personal care for up to 16 people. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. People using the service had a range of physical and learning disabilities. Some people were living with autism and some required support with behaviours that challenged.

The service had a registered manager in post. A registered manager is a person who is registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are 'registered persons'. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations, about how the service is run.

We last inspected Grove Villa Care on 20 April 2017, we found significant shortfalls and the service was rated inadequate and placed into special measures. The provider and registered manager had failed to notify CQC of notifiable events in a timely manner. Risks relating to people's care and support were not always adequately assessed or mitigated. Medicines were not managed safely. The provider had not ensured that staff had all the training they required to meet people's needs, support them consistently and keep them safe. The provider and registered manager had failed to enable and support people to communicate their preferences. People did not always receive care and support in the way they preferred and were not enabled to understand their care and support options. People did not always receive person-centred care. Staff and the registered manager were not fully aware of their individual responsibilities to identify and report abuse when providing care and treatment. People were not fully protected from abuse and the registered manager had not followed the correct procedures to make sure people were as safe as possible. The provider and registered manager had failed to establish and operate systems to assess, monitor and improve the quality of the services provided and reduce risks to people. The provider and registered manager had failed to make suitable arrangements to respect and involve service users and had failed to maintain accurate and complete records.

We took enforcement action and issued a warning notice relating to ‘Safe Care and Treatment.’ We placed a positive condition on the provider’s registration, asking them to send us monthly updates regarding the service. We required the provider to make improvements and the service was placed in special measures. Services that are in special measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. At this inspection we found that improvements had been made in some areas, however there were still serious concerns regarding the provider’s oversight and overall management of the service and some continued breaches of the regulations.

The service was not fully working towards Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen. People were not supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible; the policies and systems in the service did not always support this practice. Some people were not allowed to access their kitchen, even though they wanted to, as staff described it as ‘unsafe.’ No risk assessment had been completed regarding the risk of people using the kitchen and no plans were in place to increase people’s independence and skills.

At our last inspection, ri

The inspection took place on 20 April 2017 and was unannounced.

Grove Villa is a large detached house in a quiet residential area, it shares a site with two other services owned by the same provider. It provides care and support for up to 16 people, with a learning disability. There were 16 people living at the service when we visited.

There is a registered manager working at the service. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. The providers changed to a limited company in April 2016.

The culture of the service, was one that staff 'did for' people rather than ‘with them’, which is in contrary to best practice when supporting people with learning disabilities and meant people did not learn and develop.

People were not involved in developing and updating their care plans. People’s care plans were not always person centred and some contained inaccurate information. Staff knew people well, some interactions between people and staff positive but people with more complex support needs had limited interaction from the staff. People were not always treated with dignity and respect, the language used to describe people was not always respectful and indicated that staff were in control of the environment instead of people. For example staff described people as being rude and told one person to return to bed as it was too early to get up.

There was a board in the dining room letting people know what activities were happening each day; however this was not being used so people did not know what was on offer. Staff had been advised to use communication tools with some people but this was not happening.

Some people attended local day services and took part in other activities they enjoyed. Other people who had more complex support needs or who could show behaviours which could challenge had limited opportunities to take part in activities or go out and about. Some people had not left the service, except to attend medical appointments for several months. There were no goals recorded for people or plans to help people reach their goals or develop new skills.

People told us they felt safe at the service. Staff told us about different types of abuse and said they would report any concerns to the registered manager or the Care Quality Commission. However, we found six incidents had been recorded, which were potentially abusive. The registered manager said they were unaware of the incidents and had not reported them to the local safeguarding team. We asked the registered manager to speak with the local duty team at social services to discuss these issues, and they contacted them whilst we were there.

Some risks to people were identified, however one person did not have a risk assessment around choking despite this being highlighted by the local community team as a risk. Some risk assessments gave staff the guidance needed to manage and minimise the risks, but others did not. People did not have personal emergency evacuation plans to detail what support they needed to leave the premises in an emergency such as a fire. Risks to the environment were assessed and managed safely.

People’s medicines were not always managed safely. Staff signed medicines records before giving medicines to people and did not always have the guidance needed around the use of ‘as and when required’ medicines. People were not always given emergency medicines in line with guidance from a health care professional.

Most staff were recruited safely, however one staff member did not have any references on file. Staff had induction training and were introduced to people by established staff before supporting them. Staff completed basic training; however further training was r